| NPI | 1407821499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003445) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 3445) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2022-02-04 |